Mixed autoimmune hemolytic anemia

Mixed autoimmune hemolytic anemia (MAIHA) is a type of autoimmune hemolytic anemia which combines the features of cold sensitive antibody-induced diseases and warm autoimmune hemolytic anemia. The work-up for diagnosis is complex and the condition can be over-diagnosed.[1][2]

Mixed autoimmune hemolytic anemia
SpecialtyHematology

People diagnosed with warm autoimmune hemolytic anemia (WAIHA) caused by immunoglobulin G (IgG)[3] may also have a high number of immunoglobulin M (IgM) antibodies. These antibodies are active at room temperature, but are believed to be harmless since they are not the main antibodies responsible for WAIHA.

However, studies revealed the existence of a few cases of WAIHA that may also carry cold agglutinin antibodies that are active at the environment where the temperatures is generally equal to or warmer than 30 °C (86 °F). Such coexistence suggests a diagnosis of the mixed (warm- and cold-antibody) autoimmune hemolytic anemia abbreviated as MAIHA.[4]

Mixed warm and cold AIHA runs a chronic course with severe intermittent exacerbations, such as serious anemia, and is treated by blood transfusion. Successful therapeutic options for the treatment of hemolysis associated with mixed AIHA are limited but increasing.[5][6]

In the past, there were two obvious sources of error regarding the diagnosis of AIHA. First, patients with w-AIHA can produce low-titer, low-thermal amplitude CA of no clinical significance. Second, up to 20% of patients with CAD have IgG on the RBC surface in addition to C3d.[7][1][6]

See also

References
  1. Mayer, Beate; Yürek, Salih; Kiesewetter, Holger; Salama, Abdulgabar (2008). "Mixed-type autoimmune hemolytic anemia: differential diagnosis and a critical review of reported cases". Transfusion. Wiley. 48 (10): 2229–2234. doi:10.1111/j.1537-2995.2008.01805.x. ISSN 0041-1132. PMID 18564390. S2CID 46182439.
  2. Berentsen, Sigbjørn; Sundic, Tatjana (2015-01-29). "Red Blood Cell Destruction in Autoimmune Hemolytic Anemia: Role of Complement and Potential New Targets for Therapy". BioMed Research International. Hindawi Limited. 2015: 363278. doi:10.1155/2015/363278. ISSN 2314-6133. PMC 4326213. PMID 25705656.
  3. "Orphanet: Autoimmune hemolytic anemia, warm type". Orphanet. 2019-02-14. Retrieved 2019-02-15.
  4. Das, SudiptaSekhar; Chakrabarty, Ritam; Zaman, RU (2018). "Immunohematological and clinical characterizations of mixed autoimmune hemolytic anemia". Asian Journal of Transfusion Science. Medknow. 12 (2): 99–104. doi:10.4103/ajts.ajts_105_17. ISSN 0973-6247. PMC 6327768. PMID 30692792.
  5. Gupta, Shilpi; Szerszen, Anita; Nakhl, Fadi; Varma, Seema; Gottesman, Aaron; Forte, Frank; Dhar, Meekoo (2011-04-19). "Severe refractory autoimmune hemolytic anemia with both warm and cold autoantibodies that responded completely to a single cycle of rituximab: a case report". Journal of Medical Case Reports. Springer Nature. 5 (1): 156. doi:10.1186/1752-1947-5-156. ISSN 1752-1947. PMC 3096571. PMID 21504611.
  6. Berentsen, Sigbjørn; Sundic, Tatjana (2015-01-29). "Red Blood Cell Destruction in Autoimmune Hemolytic Anemia: Role of Complement and Potential New Targets for Therapy". BioMed Research International. Hindawi Limited. 2015. 363278-1–363278-11. doi:10.1155/2015/363278. ISSN 2314-6133. PMC 4326213. PMID 25705656.
  7. Berentsen, S; Ulvestad, E; Langholm, R; Beiske, K; Hjorth-Hansen, H; Ghanima, W; Sørbø, JH; Tjønnfjord, GE (2006). "Primary chronic cold agglutinin disease: a population based clinical study of 86 patients". Haematologica. 91 (4): 460–6. ISSN 0390-6078. PMID 16585012.
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